Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Chronic Neuropathic Pain

Summary Outcomes

Potential beneficial outcomes:

• Pain relief (with multiple measures of pain relief considered)
• Reduced consumption of health-care resources (including medication)
• Improved ability to engage in the activities of daily living
• Improved quality of life
• Patient satisfaction with treatment
• Improvement in symptoms of depression
• Return to work in patients whose uncontrolled chronic pain was the only impediment to gainful employment
• Improved neurologic function might occur as an indirect benefit of pain control or discontinuation of other treatment (such as use of opioids)

Potential side effects:

• A change in paresthesia corresponding to change in posture is normal and seldom causes a problem.
• Extraneous paresthesia or motor responses usually can be avoided by careful electrode implantation and postoperative adjustment or by use of an insulated surgical plate/paddle electrode.
• Unless it is a symptom of infection, pain/irritation from any component of the system can generally be treated topically, but surgical revision is necessary in some cases.

Risks associated with SCS:

• Spinal cord or nerve injury
• Dural puncture
• Epidural hematoma
• Infection

Possible complications:

• Electrode migration causing loss of pain/paresthesia overlap (reassign contacts or revise electrode)
• Implanted pulse generator failure (replace)
• Electromechanical failure of lead or extension cable (replace)
• Loss or reduction of pain relief despite paresthesia coverage of pain (can be treated with adjuvant medical therapy)